Faroux Laurent, Chen Shmuel, Muntané-Carol Guillem, Regueiro Ander, Philippon Francois, Sondergaard Lars, Jørgensen Troels H, Lopez-Aguilera José, Kodali Susheel, Leon Martin, Nazif Tamim, Rodés-Cabau Josep
Quebec Heart and Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Quebec G1V4G5, Canada.
Columbia University Medical Center, New York-Presbyterian Hospital, 177 Fort Washington Avenue, New York, NY 10032, USA.
Eur Heart J. 2020 Aug 1;41(29):2771-2781. doi: 10.1093/eurheartj/ehz924.
The clinical impact of new-onset persistent left bundle branch block (NOP-LBBB) and permanent pacemaker implantation (PPI) on transcatheter aortic valve replacement (TAVR) recipients remains controversial. We aimed to evaluate the impact of (i) periprocedural NOP-LBBB and PPI post-TAVR on 1-year all-cause death, cardiac death, and heart failure hospitalization and (ii) NOP-LBBB on the need for PPI at 1-year follow-up.
We performed a systematic search from PubMed and EMBASE databases for studies reporting raw data on 1-year clinical impact of NOP-LBBB or periprocedural PPI post-TAVR. Data from 30 studies, including 7792 patients (12 studies) and 42 927 patients (21 studies) for the evaluation of the impact of NOP-LBBB and PPI after TAVR were sourced, respectively. NOP-LBBB was associated with an increased risk of all-cause death [risk ratio (RR) 1.32, 95% confidence interval (CI) 1.17-1.49; P < 0.001], cardiac death (RR 1.46, 95% CI 1.20-1.78; P < 0.001), heart failure hospitalization (RR 1.35, 95% CI 1.05-1.72; P = 0.02), and PPI (RR 1.89, 95% CI 1.58-2.27; P < 0.001) at 1-year follow-up. Periprocedural PPI after TAVR was associated with a higher risk of all-cause death (RR 1.17, 95% CI 1.11-1.25; P < 0.001) and heart failure hospitalization (RR 1.18, 95% CI 1.03-1.36; P = 0.02). Permanent pacemaker implantation was not associated with an increased risk of cardiac death (RR 0.84, 95% CI 0.67-1.05; P = 0.13).
NOP-LBBB and PPI after TAVR are associated with an increased risk of all-cause death and heart failure hospitalization at 1-year follow-up. Periprocedural NOP-LBBB also increased the risk of cardiac death and PPI within the year following the procedure. Further studies are urgently warranted to enhance preventive measures and optimize the management of conduction disturbances post-TAVR.
新发持续性左束支传导阻滞（NOP-LBBB）和永久性起搏器植入（PPI）对经导管主动脉瓣置换术（TAVR）接受者的临床影响仍存在争议。我们旨在评估（i）TAVR围手术期NOP-LBBB和术后PPI对1年全因死亡、心源性死亡和心力衰竭住院的影响，以及（ii）NOP-LBBB对1年随访时PPI需求的影响。
我们在PubMed和EMBASE数据库中进行了系统检索，以查找报告NOP-LBBB或TAVR术后围手术期PPI的1年临床影响原始数据的研究。分别获取了30项研究的数据，其中包括7792例患者（12项研究）和42927例患者（21项研究），用于评估TAVR后NOP-LBBB和PPI的影响。在1年随访时，NOP-LBBB与全因死亡风险增加相关[风险比（RR）1.32，95%置信区间（CI）1.17-1.49；P＜0.001]、心源性死亡（RR 1.46，95%CI 1.20-1.78；P＜0.001）、心力衰竭住院（RR 1.35，95%CI 1.05-1.72；P = 0.02）以及PPI（RR 1.89，95%CI 1.58-2.27；P＜0.001）。TAVR术后围手术期PPI与全因死亡风险较高相关（RR 1.17，95%CI 1.11-1.25；P＜0.001）和心力衰竭住院（RR 1.18，95%CI 1.03-1.36；P = 0.02）。永久性起搏器植入与心源性死亡风险增加无关（RR 0.84，95%CI 0.67-1.05；P = 0.13）。
TAVR术后NOP-LBBB和PPI与1年随访时全因死亡和心力衰竭住院风险增加相关。围手术期NOP-LBBB在术后一年内也增加了心源性死亡和PPI的风险。迫切需要进一步研究以加强预防措施并优化TAVR后传导障碍的管理。
